학술논문
Radiation-induced brachial plexus toxicity after SBRT of apically located lung lesions.
Document Type
Academic Journal
Author
Lindberg K; a Department of Oncology and Pathology , Karolinska Institutet , Stockholm , Sweden.; b Section of Head, Neck, Lung and Skin tumors, Department of Cancer , Karolinska University Hospital , Stockholm , Sweden.; Grozman V; c Department of Molecular Medicine and Surgery , Karolinska Institutet , Stockholm , Sweden.; d Section of Thoracic Radiology, Department of Radiology , Karolinska University Hospital , Stockholm , Sweden.; Lindberg S; a Department of Oncology and Pathology , Karolinska Institutet , Stockholm , Sweden.; e Department of Cancer , Karolinska University Hospital , Stockholm , Sweden.; Onjukka E; f Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine , Karolinska University Hospital , Stockholm , Sweden.; Lax I; a Department of Oncology and Pathology , Karolinska Institutet , Stockholm , Sweden.; f Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine , Karolinska University Hospital , Stockholm , Sweden.; Lewensohn R; a Department of Oncology and Pathology , Karolinska Institutet , Stockholm , Sweden.; b Section of Head, Neck, Lung and Skin tumors, Department of Cancer , Karolinska University Hospital , Stockholm , Sweden.; Wersäll P; a Department of Oncology and Pathology , Karolinska Institutet , Stockholm , Sweden.; g Section of Radiotherapy, Department of Cancer , Karolinska University Hospital , Stockholm , Sweden.
Source
Publisher: Informa Healthcare Country of Publication: England NLM ID: 8709065 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1651-226X (Electronic) Linking ISSN: 0284186X NLM ISO Abbreviation: Acta Oncol Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose : To evaluate the rate and dose response of brachial plexus toxicity post stereotactic body radiation therapy (SBRT) of apically situated lung lesions. Material/methods: We retrospectively identified all patients with apically located tumors, defined by the epicenter of the tumor being located superiorly to the aortic arch, and treated with SBRT between 2008 and 2013. Patients with a shorter follow-up than 6 months were excluded. Primary aim was to evaluate radiation-induced brachial plexopathy (RIBP). Dose to the plexus was assessed by a retrospective delineation of the brachial plexus on the CT used for treatment planning. Then, D max , D 0.1cc , D 1cc and D 3.0cc of the brachial plexus were collected from the dose-volume histograms (DVH) and recalculated to the biologically effective dose (BED) using α/β = 3 Gy. A normal tissue complication probability (NTCP) model, based on four different dose-volume parameters (BED 3,max , BED 3,0.1cc, BED 3,1.0cc, BED 3,3.0cc ) was fitted to the data. Results: Fifty-two patients with 56 apically located tumors were identified. Median prescription dose per fraction was 15 Gy (range 6-17) and median number of fractions was 3 (3-10). With a median follow-up of 30 months (6.1-72) seven patients experienced maximum grade 2 (scored 3 times) or 3 (scored 4 times) RIBP after a median of 8.7 months (range 4.0-31). Three patients had combined symptoms with pain, sensory and motor affection and four patients had isolated pain. Median BED 3,max for the patients experiencing RIBP was 381 Gy (range 30-524) versus BED 3,max of 34 Gy (range 0.10-483) for the patients without RIBP. The NTCP models showed a very high predictive ability (area under the receiver operating characteristic curve (AUC) 0.80-0.88). Conclusion: SBRT of apically located lung lesions may cause severe neurological symptoms; for a three-fraction treatment, we suggest that the maximum dose to the plexus should be kept ≤30 Gy (130 Gy BED 3 ).